Steroid-sparing therapy important in pandemic, SECURE-IBD registry shows

Assistant Professor Ryan Ungaro

Findings from the SECURE-IBD registry confirm many of the observed risk factors for severe COVID-19 disease in the general population apply to patients with Crohn’s disease and ulcerative colitis.

The data from 528 mostly white patients from 33 countries, published in Gastroenterology, showed older age, two or more comorbidities, and systemic corticosteroid use were associated with severe COVID-19 in IBD patients.

The patients’ IBD was mostly in remission (58.9%) or considered mild (19%).

Gender, type of IBD, IBD severity, smoking status and BMI were not associated with any indicator of severe COVID-19.

The study found 31% of the total cohort required hospitalisation, 5% in ICU and 4% on a ventilator. There was a 3% case fatality rate.

The primary endpoint, a composite of ICU, ventilator use and death, was seen in 7% of patients.

No significant association was seen between TNF inhibitor use and the primary endpoint, however 5-ASA/sulfasalazine use was positively associated with the outcome of hospitalisation or death.

Patients ranged from five to >90 years of age (median 41 years) but as seen elsewhere, children were less likely to have severe COVID-19 disease.

“We note no deaths occurred in the 29 reported cases occurring in patients <20 years of age, extending the findings of an earlier case series suggesting a milder course of COVID-19 in pediatric patients,” the study authors said.

“In contrast, 50% of deaths occurred in patients over 70 years of age and 50% of patients who died had cardiovascular comorbidities.”

Study co-author Assistant Professor Ryan Ungaro, a gastroenterologist at Mount Sinai Hospital’s Feinstein IBD Center, said in a statement that one of the main takeaways for the IBD community was that maintaining remission with steroid-sparing treatments was important during the pandemic.

“Our finding that TNF antagonist therapy is not associated with severe COVID-19 is reassuring news in light of the large number of patients who require this therapy, currently the most commonly prescribed biologic therapy for IBD patients,” he said.

The study did note however a higher risk of hospitalisation and/or death with TNF antagonists in combination with immunomodulator therapy versus monotherapy.

Associate Professor was a special guest on the limbic’s recent webinar Managing IBD during a pandemic.

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